scholarly journals A Usability and Feasibility Study: GENIE - An App Supporting Self-Management among Older Adults who are High Users of the Health Care System (Preprint)

2020 ◽  
Author(s):  
Ruta Valaitis ◽  
Laura Cleghorn ◽  
Ivaylo Vassilev ◽  
Anne Rogers ◽  
Jenny Ploeg ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Health Care ◽  
Social Networks ◽  
Social Services ◽  
Health Care System ◽  
Self Management ◽  
Health And Social Services ◽  
Primary Care Clinicians ◽  
Care System

BACKGROUND Primary care providers have been tasked with fostering self-management through managing referrals and linking patients to community-based health and social services. This study evaluated a web-based tool –GENIE (Generating Engagement in Network InvolvEment)– as a component of the Health TAPESTRY program to support self-management of older adults who are high health care system users. GENIE aims to empower patients to leverage their personal social networks to access community services towards reaching their health goals. GENIE maps client’s personal networks, elicits preferences, and filters local health and social resources from a community service directory based on results of a questionnaire that explores client’s interests. In the Health TAPESTRY program, volunteers conducted home visits to gather health information on tablets and implemented the GENIE tool. A report was generated for the primary care team for follow up. OBJECTIVE This study examined the usability, feasibility, and perceived outcomes of the implementation of GENIE with older adults who were enrolled in Ontario’s Health Links Program, which coordinates care for the highest users of the health care system. METHODS This study involved two primary care clinician focus groups, one clinician interview, a volunteer focus group, client telephone interviews, field observations, and GENIE utilization statistics. RESULTS Eight patients, three volunteers, and 16 primary care clinicians participated. Patients were most interested in services that were health-related (exercise and socialization). Overall, participants perceived GENIE to be useful and easy to use, despite challenges related to email set up, disease terminology, instructions for personal network mapping, and clarity of questionnaire items. Volunteer facilitation was critical to support implementation of Genie. Tool completion averaged 39 minutes. Almost all patients identified a community program or activity of interest using GENIE. Half followed up on health and social services and added new members to their network over 6 months, while one participant lost a member. Clinicians had concerns about accuracy, suitability, and quantity of suggested programs and services generated from the tool and believed that they could better tailor choices for their patients highlighting the inherent tension between user-centred preferences focused on capabilities and bio-medical definitions of need shaping professional judgement. However, clinicians did note that GENIE strengthened their understanding of patients’ personal social networks. CONCLUSIONS This study demonstrated GENIE’s potential, facilitated by volunteers, to expand patients’ social networks and link them to relevant health and social services to support self-management. Volunteers require training to effectively implement GENIE for self-management support and can help overcome time limitations that primary care clinicians face. Refining the filtering capability of GENIE to allow for better tailoring of results to address the complex needs of those who are high system users may help to improve primary care provider’s confidence in such tools. CLINICALTRIAL Not applicable

scholarly journals Implementation of the Stopping Elderly Accidents, Deaths, and Injuries Initiative in Primary Care: An Outcome Evaluation

2018 ◽  
Vol 59 (6) ◽  
pp. 1182-1191 ◽  
Author(s):  
Yvonne A Johnston ◽  
Gwen Bergen ◽  
Michael Bauer ◽  
Erin M Parker ◽  
Leah Wentworth ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Health Care ◽  
At Risk ◽  
Health Care System ◽  
Fall Risk ◽  
Outcome Evaluation ◽  
Primary Care Visit ◽  
Not At Risk ◽  
Care System

Abstract Background and Objectives Older adult falls pose a growing burden on the U.S. health care system. The Centers for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative was developed as a multifactorial approach to fall prevention that includes screening for fall risk, assessing for modifiable risk factors, and prescribing evidence-based interventions to reduce fall risk. The purpose of this study was to determine the impact of a STEADI initiative on medically treated falls within a large health care system in Upstate New York. Research Design and Methods This cohort study classified older adults who were screened for fall risk into 3 groups: (a) At-risk and no Fall Plan of Care (FPOC), (b) At-risk with a FPOC, and (c) Not-at-risk. Poisson regression examined the group’s effect on medically treated falls when controlling for other variables. The sample consisted of 12,346 adults age 65 or older who had a primary care visit at one of 14 outpatient clinics between September 11, 2012, and October 30, 2015. A medically treated fall was defined as a fall-related treat-and-release emergency department visit or hospitalization. Results Older adults at risk for fall with a FPOC were 0.6 times less likely to have a fall-related hospitalization than those without a FPOC (p = .041), and their postintervention odds were similar to those who were not at risk. Discussion and Implications This study demonstrated that implementation of STEADI fall risk screening and prevention strategies among older adults in the primary care setting can reduce fall-related hospitalizations and may lower associated health care expenditures.

Primary-Care Visits and Hospitalizations for Ambulatory-Care–Sensitive Conditions in an Inner-City Health Care System

2003 ◽  
Vol 3 (6) ◽  
pp. 324-328 ◽  
Author(s):  
John F. Steiner ◽  
Patricia A. Braun ◽  
Paul Melinkovich ◽  
Judith E. Glazner ◽  
Vijayalaxmi Chandramouli ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Inner City ◽  
Ambulatory Care ◽  
Health Care System ◽  
Ambulatory Care Sensitive Conditions ◽  
Care System ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

The importance of health literacy for self-management: A scoping review of reviews

2021 ◽  
pp. 174239532110354
Author(s):  
Marieke van der Gaag ◽  
Monique Heijmans ◽  
Cristina Spoiala ◽  
Jany Rademakers
Keyword(s):  
Health Care ◽  
Health Literacy ◽  
Health Care System ◽  
Medical Management ◽  
Self Management ◽  
Limited Health Literacy ◽  
Limited Health ◽  
Behavioural Aspects ◽  
The Relationship ◽  
Care System

Objectives Self-management of chronic diseases is rather complex, especially for patients with limited health literacy. In this review, we aim to disentangle the specific difficulties patients with limited health literacy face in relation to self-management and their associated needs with respect to self-management support. Methods We performed a literature search in five databases. We used a broad definition of health literacy and self-management was categorized into four types of activities: medical management, changing lifestyle, communicating and navigating through the health care system and coping. Included reviews described the relationship between health literacy and different domains of self-management and were published after 2010. Results A total of 28 reviews were included. Some clear difficulties of patients with limited health literacy emerged, predominantly in the area of medical management (especially adherence), communication and knowledge. Other associations between health literacy and self-management were inconclusive. Barriers from the patients’ perspective described mainly medical management and the communication and navigation of the health care system. Discussion Patients with limited health literacy experience difficulties with specific domains of self-management. For a better understanding of the relationship between health literacy and self-management, a broader conceptualization of health literacy is warranted, including both cognitive and behavioural aspects.

The Education of Pediatricians for Primary Care: The Score After Two Score Years

PEDIATRICS ◽  
1995 ◽  
Vol 95 (2) ◽  
pp. 270-272
Author(s):  
Evan Charney
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care System ◽  
Medical Profession ◽  
Primary Care System ◽  
Educational Structure ◽  
Task Forces ◽  
Do So ◽  
Care System

In a 1973 monograph on the education of physicians for primary care, Joel Alpert and I wrote, "There are two interrelated and serious problems in our present educational structure—not enough physicians enter primary care and those who do so are not adequately prepared for the job."1 Twenty years and many task forces and exhortatory editorials later, much the same could be said. But that conclusion would not be entirely fair: changes have indeed occurred in the subsequent two score years. There is now clear consensus that a strong primary care system should be the linchpin of our nation's health care system, with 50 to 60% of physicians as generalists, 2,3 and the medical profession has at least professed to agree with that strategy.4

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